What have you been reading, hearing or TV viewing that has provoked some feelings of comfort or concern about what is happening in the world of medicine, medical care, treatment or science? Ethics is all about doing the right thing. Are you aware of any issues in medicine or biologic science which are being done right, could be improved or in fact represent totally unethical behavior?
Write about them here.. and I will too! ..Maurice (DoktorMo@aol.com)

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Tuesday, September 20, 2005

An article in the J Gen Intern Med. 2004 Sep;19(9):905-10 titled “Is physician self-disclosure related to patient evaluation of office visits?” by MC. Beach et al describes a study about how patients,reporting after either a primary care visit or surgical visit, felt about the visit in which the physician self-disclosed “a personal experience that had medical and/or emotional relevance for the patient.” The study involved 1,265 patients who visited 59 primary care physicians and 65 surgeons. Self-disclosure was not found to be rare since “physician self-disclosure occurred in 15.4% of routine office visits, and there was no statistically significant difference in the prevalence of self-disclosure at the visit level between surgery and primary care (17%[102/589] of primary care visits and 14%[93/676] of surgical visits). “

The results showed statistically that “fewer patients reported feelings of warmth/friendliness (37% vs 52%; P =.008) and reassurance/comfort (42% vs 55%; P =.027), and fewer reported being very satisfied with the visit” following self-disclosure by a primary care physician. On the other hand, “following visits in which a surgeon self-disclosed, more patients reported feelings of warmth/friendliness (60% vs 45%; P =.009) and reassurance/comfort (59% vs 47%; P=.044), and more reported being very satisfied with the visit (88% vs 75%; P =.007)”

The conclusion was “Physician self-disclosure is significantly associated with higher patient satisfaction ratings for surgical visits and lower patient satisfaction ratings for primary care visits. Further study is needed to explore these intriguing findings and to define the circumstances under which physician self-disclosure is either well or poorly received.”

Of course, read the article for details but if verified the question is why should surgeons have better patient responses to self-disclosure? The authors suggest “Facing an invasive procedure with an unknown outcome and inherent risk, surgical patients may be more acutely anxious and vulnerable than primary care patients. Within this context, every form of self-disclosure seemed to be appreciated by patients, but especially evident was the higher satisfaction of surgical patients (in contrast to primary care patients) when the disclosure was characterized as reassuring. Self-disclosure from a surgeon may function as a sign of personal interest and emotional support.” On the other hand , primary care physicians “are more involved in chronic disease management in which cure is often not a realistic goal.” In view of this difference in outcome, “it is not hard to imagine that reassurance in the primary care context, while well-intentioned, might be heard as premature and promising something that cannot easily be delivered. Perhaps in the context of chronic illness, reassuring disclosures appear dismissive or to invalidate a patient's concerns.”

I would appreciate self disclosure from any of my physicians because it would show that they cared enough to take the risk, it would possibly give me comfort and and additional knowledge from someone who has walked the walk.

There would be a positive emotional component that would elicit even more trust both because the doc took it to a deeper level and because the doc experienced it and came or is coming through it. Of course there are different variables.

My respect, trust and appreciation would most definitely go up for that physician.

Kilo2tango, from last year, I am not sure that your comment is at all pertinent to the current thread but it is interesting. Bioethics, as a discipline of philosophy has never had the power or the duty given by society to attempt to stop people from making their own decision. Those who participate in bioethics simply review the current views and consensus and measure them against ethical guidelines and principles which have developed over the ages.If those who claim they were bioethicists had any more power than anyone else, they should have prevented the starting of the Iraq war.

Snowlite, there is some concern, however, that physicians must be cautious in revealing too much of themselves since the professionally established direction of therapy is toward the patient and not toward the doctor. ..Maurice.

Dr Bernstein- this went longer than I intended and so please feel free to delete and or respond accordingly. Oh...I am Snowlite. When I stopped in here earlier I forgot I was in my other private blog. My regular one is "it's a wonderful life".

I left another comment but don't remember where. You have a lot of good posts here. I will have to notate which ones I leave a response on.

I can appreciate the concern there and so I think the Doc first should be discerning as to which pt would benefit from such disclosure as well as process info appropriately, then with boundaries in mind...self disclose away.

I have been going to my uro doc for a chronic condition for 22 mos. now and there is a bond/good pt/dr relationship. I have been to him more than any physician (including OBGYNS) and he has done more invasive work than anyone and has been an intimate professional medical case due to the nature of treatment. BTW-I am the one who commented in Medblog last nite that in modesty,even after all the exams...still put pants in front of me when undressing.

His group took my case on when I became an ER admit pt diagnosed with sepsis, pyelonephritis and hydronephrosis caused by a totally closed ureteral stricture. I was one sick lady. I have had multiple stents because ureter kept wanting to close, many procedures, tests etc.

He has always been there for me and I think has gone above and beyond in attending to my needs. I measure that against how other physicians have handled medical issues over the years, although never for anything this serious or chronic.

I am so grateful to have been under his care while going through something like this.

I know it would not have been the same if it were the 1st urologist when I had my first kidney stone (that caused all this),because while nice he wasn't as attentive or patient.

I like my current uro doc's partners-they have been great too but haven't seen them much except for when covering. AND I am very fond of his office staff - they are wonderful! Seriously-they all helped to make this difficult time more bearable!

I think so highly of all of them as individuals and of their professionalism that I would like to be a part of their team. And so I recently applied-even though I am still actively a pt.

I am believing and so is he that the renal next scan will be a good report and finally I will be able to close the door on this. I still have hydronephrosis which isn't reversing but you can still live with that and they will monitor it maybe yearly, not sure. I am being followed for another condition but nothing major.

Anyway, I did tell him I was interested and he said that he wouldn't want anything to come between us. I'm not sure what he meant by that and I didn't ask. he told me to speak to the office mgr and I did send resume in. (I am more than qualified and he knows that and my references, etc) In the end it came down to them deciding not to hire a pt.

I was deeply disappointed and frustrated because I do have an excellent rapport with all. I have even bonded with some of the women and genuinely feel close. Maybe it is just because of my frequent flier status which also make it a comfort zone.

I digressed, but I have read your stuff and I suppose this comment is layered with things you teach about. :)

Getting back to the original topic...for as close as I feel to him and for as well as I "feel" like I know him ...I don't at all.

He has given me a lot of personal attention that he could have delegated off to a nurse, etc and I know he likes me as a pt/person. He has seen me in all kinds of physical/emotional situations. I know there are times when I was anxious that I HAD to be making his job more difficult and he remained consistently patient.

As I stated..we have a good relationship-pt/doctor bond and I know I can count on him.

That being said...I am amazed that in 22 mos he has never personally revealed any personal info. Maybe a couple of really insignificant things but nothing that would be descriptive of his personal life. I didn't even know his wife had a baby last fall until I inquired about a picture. All my appointments/phone calls are always about me.

Conversely, I know "a lot" about my PCP and my OBGYN talked about himself too. I admit I enjoy hearing about their stuff and that it feels warm and friendly.

You know what is weird to me? That I can like him so much and know nothing about him. I'm not articulating this well.

PCP and I share the same theological beliefs and we get into discussions. I also know things about his family and his parents, how he came from England to Canada to here. I could go on. Good pt/dr relationship/bond.

SeaSpray, I think that the way a patient feels about a doctor is related partly as a matter of the power through his skills and accomplisments he holds over you. The other part is what you know and admire about the doctor as a person, separate from his professional role. It is clear that a patient doesn't need the presence of both. In your case, your doctor in his professional role toward you has trumped any lack of information that you know of him as a person. I think it is that simple but I would look forward for others to give their opinion. ..Maurice.

I am someone who wants to feel warmth and acceptance from my doctors. Obviously, depending on personalities and situations there are degrees.

As you can see, I adore these doctors I have mentioned, trust them implicitly, have total respect for and confidence in their abilities to facilitate healing.

And with uro doc who I who has never shared on a personal level- he is THAT good so it doesn't matter. But as I have already stated, he is excellent in caring for me.

I do have another doc who I am not crazy about but he is an excellent diagnostician. I don't feel good vibes on any level but he has been right on when making decisions opposite from what other docs have said. He's unpredictably crotchety and I can deal with that but there is this undercurrent that I can't get a handle on.

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